Will my health insurance policy cover Coronavirus? IRDAI issues guidelines on handling of claims

The Coronavirus is spreading fast and several cases have been reported in India. For those holding a health insurance policy, the pertinent question that comes to mind is, whether their claims will be settled or not and will the policy cover Coronavirus? Dispelling all sorts of confusions, this is what Dr. Shreeraj Deshpande, Chief Operating Officer, Future Generali India Insurance, has to say, “Any person who is hospitalised as a result of Coronavirus and takes treatment will be covered as any other illness. The subsequent claims will be processed as per regular norms, provided the individual has been hospitalised for 24 hours. The government has issued advisories on Coronavirus infection and insurance companies will be guided by that.”

Incidentally, the IRDAI has recently issued a set of guidelines to be followed by the insurance companies in settlement of claims arising under Coronavirus. In the health insurance policies that cover hospitalization expenses, in order to alleviate the hardships that may be caused to the policyholders, IRDAI has stated that all claims reported under coronavirus shall be handled as per the following norms.

i) Where hospitalization is covered in a product, insurers shall ensure that the cases related to Coronavirus disease (COVID-19) need to be expeditiously handled.

ii) The costs of admissible medical expenses during the course of treatment including the treatment during the quarantine period have to be settled in accordance with the applicable terms and conditions of the policy contract.

iii) All the claims reported under COVID 19 shall be thoroughly reviewed by the claims review committee before repudiating the claims.

The regulator has also asked insurers to design products covering the costs of treatment for Corona Virus similar to products introduced by them for various specific diseases including vector-borne diseases.

There is, however, a condition in most health insurance policies that exclude treatment of any pandemic disease. Till now, WHO has not declared Coronavirus as a pandemic but the risks exist. “ If Coronavirus is declared as a pandemic by WHO or Indian government, then claims may or might not be payable as such claims are excluded under many health insurance policies,” says Subramanyam Brahmajoysula, Head – Underwriting and Reinsurance, SBI General Insurance.

As of now, Coronavirus is to be fully covered as it is not even considered as a pre-existing ailment. Therefore, there is no waiting period specific to such ailments.

Buying a health insurance policy for self and family will help in meeting hospitalization cost arising out of Coronavirus and other ailments. “For availing health insurance benefit, one needs to be insured first. Without any health insurance, no coverage will be given to the individual. Also, after buying a health insurance policy, hospital expenses due to coronavirus get covered after an initial waiting period of 30 days. In today’s time most of the health insurance companies are providing yearly bonus and they reload the sum insured too, therefore, it can help you double or even triple your sum insured without paying extra,” says Sanjiv Bajaj, VC & MD, Bajaj Capital.